PROJECT SUMMARY/ABSTRACT
Black sexual minority men (SMM) suffer disproportionately from health inequities, including high rates of HIV,
mental health issues, and poor physical health. Intersectional stigma and discrimination contribute significantly
to these health inequities. Sleep health, an understudied factor, may play a crucial role in mediating these
health inequities. Based on emerging evidence from cross-sectional data indicating that self-reported sleep
may be compromised in Black and SMM populations, we propose to conduct a community-based participatory
study using a longitudinal mixed-methods design to investigate sleep health as a pathway linking intersectional
stigma and discrimination and health consequences in Black SMM. We will collect three waves (baseline, 6-
month, and 12-month follow-ups) of quantitative data using questionnaires/surveys, daily diary, and actigraphy
(objective sleep monitoring) from 300 Black SMM. In a subsample of 60 participants, we will conduct in-depth
qualitative interviews at baseline and 12-month follow-up. The proposed longitudinal mixed-methods study will:
1) examine quantitatively the proximal (daily) and longitudinal associations between intersectional
stigma/discrimination and poor sleep health among Black SMM and the extent to which coping with the stress
of discrimination mediates the longitudinal effect; 2) examine quantitatively the role of sleep health as a
mediating pathway between upstream determinants (intersectional stigma and discrimination) and health
consequences longitudinally, and the proximal associations of poor sleep on next day’s mood and substance
use; and 3) to explore qualitatively how individual/interpersonal-level (e.g., sleep behaviors, experiences of
discrimination, coping strategies) and structural-level (e.g., housing condition, neighborhood characteristics)
factors influence sleep health and how sleep is related to other health outcomes (e.g., mental and physical
health) over time. Qualitative interviews will also explore possible solutions to address the barriers identified.
Input from community members and stakeholders will be sought and incorporated throughout the study. The
mixed-methods results and community input will serve as a basis to inform sleep health promoting policies and
intervention strategies for this group. Drawing upon an established community-academic partnership, this
study will be the first longitudinal mixed-methods community-based participatory research to illuminate how
sleep health inequities contribute to health inequities affecting Black SMM. The proposed study aligns with the
goals of Healthy People 2030 and the NIH Sleep Research Plan, and addresses the needs of sexual minority
individuals highlighted in NOT-MD-22-012. Findings from this comprehensive investigation will pave the way
for tailored intervention efforts and help advance health equity for Black SMM.
